On May 18, 2004, by a vote of 331 to 88, the US House of Representatives defeated a bill sponsored by Representative Dana Rohrabacher (R-CA) that would have required hospitals to report undocumented immigrants seeking emergency care to the Department of Homeland Security (DHS) or lose certain federal funding.

The bill, titled the Undocumented Alien Emergency Medical Assistance Amendments of 2004 (HR 3722), would have required health care providers to inform the DHS about patients’ finances and employment and collect identification information, such as a fingerprint or photograph, which would also be given to the DHS.  The bill also would have narrowed the scope of health services available to undocumented immigrants and would have made inability to pay medical expenses a basis for removal from the US.  Additionally, the bill would have required the employers of undocumented workers whose medical expenses are reimbursed by the federal government to repay the government for those costs.

If passed, the bill would have penalized hospitals that did not comply by refusing to provide Federal reimbursement of hospital-provided emergency and certain transportation services.  Last year's Medicare and prescription drug benefit legislation allocated over $1 billion to reimburse hospitals for the uncompensated health care provided to illegal aliens.

Critics of the Rohrabacher bill said that it would have deterred those undocumented immigrants from seeking needed health services, including testing and treatment for communicable diseases, which could have detrimental health effects on the general population.  Additionally, the already overburdened emergency health care providers would have had to verify the immigration status of emergency patients, and report suspected undocumented immigrants to immigration authorities, which conflicts with patient privacy rights and the fundamental principle that health care providers refrain from harming their patients.

The House debate caused by this bill has lead to the introduction of a similar bill, the Country of Origin Healthcare Accountability Act (H.R. 4360), by Representative Jo Ann Davis (R-VA).  This bill proposes to provide Federal reimbursement for emergency health services given to undocumented immigrants from foreign aid funds. Under this legislation, the cost of providing treatment to undocumented immigrants would be deducted from the amount of assistance provided to foreign countries.